Nobody's Fault But Mine

(Disclaimer: I personally favor a nationalized, single-payer system of health care. I believe the recent health-care reform was a step in the right direction but nowhere near comprehensive enough.)

There’s more news out today about the climbing costs of health care. As I read more and more about insurance companies short-changing patients, I think more and more, “How can we reform the system?” I have an idea (theoretical only) that so depends on personal responsibility that I cannot believe some junior Republican congressman has not yet conceived of it: make medical insurance fault-based.

           

Within the United States of America, individual states use two different systems of car insurance: fault and no-fault. 38 states currently use a fault-based system in which a car insurer will pay out compensation according to each party’s degree of fault. Fault-based states allow for tort lawsuits by one driver against another, one driver against the other’s insurer, or by the insurer against its covered driver. In no-fault states a claimant does not have to prove that he did not cause the crash before collecting benefits.

           

Although less clear cut, the same principle applies in other insurance situations. If you burn down your house, you probably won’t collect compensation from your homeowner’s insurance policy. If a potential life insurance beneficiary murders the policy holder, as happened in the classic film noir Double Indemnity, the murderous spouse or child ain’t getting nothing.

           

Why not apply this principle to the medical insurance field? If you are at fault in getting sick or hurt, you have to pay out-of-pocket. It doesn’t even have to be black and white. Insurers could adopt the concept of “comparative fault” from tort law—a person’s medical benefits are reduced in proportion to his degree of fault in causing his medical complaint.

           

Let’s use an example. Three fifty-year-old men of similar weight and ethnicity are all diagnosed with State IV lung cancer. Patient #1 runs three miles every day. He sees his doctor regularly for check-ups. He eats all organic food. Yet for some mysterious reason, he gets lung cancer. Patient #2 started smoking at age 15. He tried several methods of quitting over the years but just couldn’t stop. Finally, with a doctor’s assistance, he managed to stay off cigarettes for the past 10 years. Still, he gets lung cancer. Patient #3 also started smoking at age 15, but he never even tried to quit. He gets lung cancer.

           

Assume all three have the same insurance coverage. Should there be a difference in the amount of out-of-pocket expenses? If we as Americans believe in personal responsibility and individuality, then yes, there should be a difference. Just as drivers must take responsibility for their individual driving records when paying insurance premiums, shouldn’t individuals take responsibility for their individual choices when insurance payouts are on the line?

           

I can hear the protests: “But Kristina, people do have to pay higher health insurance premiums if they’re unhealthy!” True, but the reason for their unhealthiness does not come into play. If Republicans really want to fix the fairness of the health-care system, they should look more closely at the reason a given individual is unhealthy.

           

Take another example: exclusively genetically-based medical conditions. Many medical conditions, most of them quite rare, are unequivocally not the fault of an individual because they are exclusively genetically-based, and yet people with these genetic conditions must still pay higher health insurance premiums or may have difficulty obtaining coverage at all. And all this based on something over which they have no control! This runs completely counter to the mantra of “personal responsibility.” Yes, charge higher premiums to the unapologetic smoker who refuses to even attempt to quit. Make him pay completely out-of-pocket for his lung cancer treatment. The drunk driver who wraps his car around a tree and injures himself should not get the privilege of public dollars. But do NOT make individuals with genetic illnesses pay for something they did not cause!

           

This idea works theoretically, but it runs into very practical problems. The unrepentant smoker (or irresponsible drunk driver) and the child with a genetic illness occupy opposite ends of the spectrum, and in their cases assigning levels of fault is very easy. For most other health complaints, however, doctors cannot accurately pinpoint whether nature or nurture caused the problem. Both genetic and environmental factors play a role in most medical issues, and determining the relative influence of those factors still vexes medical science. Some individuals will have high blood pressure no matter how much exercise they get and how many Omega-3s they ingest. Some obese individuals attempt valiantly to lose weight but just can’t keep it off. And the source of some individuals’ issues runs all the way back to childhood eating habits learned at the parental table. Should we blame adults for the mistakes their parents made during their youths?

           

So yes, apportioning blame is a hard task, especially in the field of human medicine. We do not yet know enough about the delicate balance of genetic and environmental factors. And yet lay juries apportion blame every day in car accident cases and medical malpractice cases. The jury members, who couldn’t think up an excuse to avoid jury duty and are likely dumb as rocks (or old as rocks), must decide whether a doctor’s actions fell below the professional standard of care and must determine whether Driver A ran a light or Driver B was distracted. The modern trend in these tortious settings is toward the system of “comparative fault.” Yes, the doctor may have failed to stitch the wound correctly, but the patient disobeyed direct instructions not to run around. Damages are adjusted accordingly.  

           

A fault-based medical insurance system could also accommodate a role for effort. An individual would get points for trying to quit smoking, for losing even 10 pounds, for bringing blood pressure down, and for regular preventative care. The smoker who attempts to quit but fails would pay less than the smoker who never even attempts. This creates incentives for individuals to take personal responsibility for themselves.

           

And of course, a fault-based system would have an exception for a natural part of life still bizarrely classified as a medical “condition:” pregnancy. Pregnancies, at least if you believe in science and do not read the Bible literally, tend to come about because of very specific human action.

           

Then there’s the big question of healthcare for senior citizens. Is aging your own fault? Admittedly, a fault-based system of health insurance would not solve the problem of ballooning costs for medical coverage for the elderly. We must continue to look elsewhere for a route out of that labyrinthine mess.

Republicans currently want to deny medical care for anyone who gets sick regardless of the causes of illness. Democrats currently want to give medical care to everyone regardless of the cause of complaints. True compromise on this subject requires an inquiry into the reasons people require medical care. Republicans chant their mantra of “personal responsibility” all day, but in this area they fail to see a golden opportunity to actually apply their theoretical position to a real-world problem.

http://www.glamour.com/sex-love-life/blogs/smitten/2011/08/5-dating-dealbreakers-to-recon.html

"A person would have to be pretty extraordinary in other ways to make up for low income, never paying, poor finances (lots of debt), roommates, and marriage hesitancy. However, it isn't beyond comprehension."

"Sorry but settling is settling. If these things weren't dealbreakers to you to begin with then fine, but I sure wouldn't settle for an unemployed guy who didn't want to get married. There are still people who are doing well, even in this economy. No you can't set your standards TOO high, but I think it's reasonable to expect a certain level of financial stability."

"I disagree, totally with #2...a bad economy should not be an excuse for guys to stop being gentlemen, strive for chivalry, ladies! I believe that if he REALLY, REALLY likes you, he'll WANT to take care of the check..."

A recent post on the Glamour magazine website (see the link above) listed five dating “dealbreakers” to reconsider in this economy. The actual list is not very surprising, and I personally agree with the thrust of the article. In such dire economic circumstances and with the entire globe suffering financially, men and women playing the dating game should stop putting so much emphasis on status and wealth.

           

The comments, however, really surprised me. (I pasted the ones that annoyed me the most). Perhaps only women employed and bringing home big fat paychecks commented on this post. Perhaps the ones happily dating underemployed men were too embarrassed to comment. Or perhaps the women who read Glamour tend to be superficial gold-diggers. Regardless of the explanation, the lack of compassion and understanding and the unwillingness to look beyond a person’s name, job title, and account balance really distress me.

           

I thought that in the 21st century women had graduated to caring more about the portfolio of a man’s character than his stock portfolio. While for most of human civilization the institution of marriage has carried explicit economic overtones, the three hundred years since the Romantic movement of the 18th and 19th centuries have spread the idea of marriage based on romantic love: you marry the person you love, not the pocketbook your family wants. Some cultures still arrange marriages out of economic, rather than emotional, compatibility, but in 21st century mainstream America, if women do not wanted to be treated as simply walking vaginas, then it follows that those same women should not treat men as simply walking wallets. An individual is not just a job, a place to sleep, and a dinner to pay for. Every individual, regardless of career path, has dreams, desires, flaws, faults, hobbies, interests, and passions. I sincerely hope that the women of the United States can see that.

           

Perhaps the lukewarm reaction to this list has something to do the Carrie Bradshaw-fueled regression back into 18th century mores. Carrie Bradshaw, heroine and icon of the 90s and 00s, was disgustingly materialistic, as financially unstable as 1920s Germany, and yet, strangely, prone to dating very rich men. She ended up with the gazillion-aire Mr. Big, whose economic capacity greatly exceeded his emotional capacity. The Sex and the City viewer always knew about the content of Mr. Big’s bank account: he was the next Donald Trump, wore fantastic suits, stayed at lavish hotels, bought vineyards in Napa, and could fly off to Paris at a moment’s notice. The viewer never saw too many positive figures in the account book of Mr. Big’s character, however: he lied, cheated, neglected Carrie, and couldn’t commit emotionally. He did like jazz and did have a great record collection, but he went to the opera only to please his wife. We do see him read the newspaper, but we never hear him offer his opinion on literature or art.

           

Even more than the possible over-appreciation of a questionable cultural touchstone, what troubles me about the comments in response to the Glamour posting is a lingering problem with feminism and the modern role of womanhood. Women in the 20th century worked extremely hard to get men to see a woman as an individual—as a whole being with a mind and a body—instead of just a replaceable cog in an economic and reproductive system. Now, it seems that some women in the 21st century will not do the same for men.  

Even the Losers Get Lucky Sometimes

Season 4 of Breaking Bad has been wildly uneven and in many respects has veered off course from the storytelling that made the first three seasons so wildly compelling, but last night’s episode got back on track and in fact epitomized what I believe is one of the main points of the show as a whole.

“Maybe I’m not such a loser after all.” –Jesse Pinkman

Jesse says this to Walter White during a heated argument about the recent efforts of Gus and Mike to boost Jesse’s fragile self-esteem. If you asked me to sum up the theme of Breaking Bad in one sentence, I would choose that line of dialogue. Most of the main characters in this show—Walter, Skylar, Jesse, even Hank—are all trying to prove, both to themselves and to the world, that they are not losers.

Walter did not say it as explicitly as Jesse did, but his words and actions in last night’s episode clearly showed that he will not go back to playing the “loser.” As his wife Skylar proposes going to the police—which suggests Walt’s weakness and ineffectualness—Walter snaps back, “I am the danger...I am the one who knocks.” Walt emotionally, mentally, and even physically cannot listen to his wife berate his abilities and belittle his importance. He will not be a loser. And he will make his wife understand this.

Later in the episode, Walt takes possession of the car wash from his former boss, the sniveling, greasy, undermining Bogdan. When Walt worked as a cashier for Bogdan, he had reached his low point of Loserville.  Now he comes back to the car wash not as a Loser, but as a powerful, capable Boss. Watching the scene, I expected Walt to explode at Bogdan and show off his new take charge personality. Instead, the clever writers of Breaking Bad gave Walt something much more subtle, yet much more powerful, to do. Walt takes a framed dollar off the wall—the proverbial “first dollar I ever earned” that immigrant Bogdan has saved all these years—and uses it to buy a Coke. It’s a brilliant way of saying that Walter believes in himself, in his abilities, in his own power. He no longer even cares enough about Bogdan to shout and scream and swear. He has risen so far above Loser status that all Bogdan is worth to him anymore is a can of Coca-Cola.

From the very beginning of the show—from when we saw Walter White as the ultimate Nobody—Breaking Bad has always been about asserting one’s identity. Instead of taking charity from a rich former partner, Walter asserted his skills and knowledge to cook meth. He graduated to asserting himself physically, violently killing a number of people throughout the series. He asserts himself with his wife daily, refusing to give in to her passive-aggressive behavior. On last week’s episode, when he told Hank that Gale Boetticher was not the real meth mastermind, Walt subtly asserted himself as the real genius.

Perhaps this explains why Breaking Bad has struck such a chord with its small but devoted audience. In the midst of economic crisis and governmental stalemate, perhaps viewers applaud Walt’s continuing refusal to take shit from anyone. Walt has transformed from a classic Loser—“ineffectual” is the word that keeps coming to my mind to describe him—into a Boss. Along the way, so has Jesse, and even at times, so has Skylar. Walt has finally started participating in his own life and taking responsibility for his actions. He has finally asserted himself! True, he has done so by cooking meth, but the methods of assertion are less important than the assertion itself.

To me, this show is not ultimately about the temptation of crime, the thrill of illegal activities, or even about “providing for one’s family,” as Gus says. It is about normal people standing up and saying, “I won’t take shit from anyone. I’m not a loser.”

And with that message, the writers and creators of Breaking Bad have created the ultimate television show for the Great Recession. They have tapped into a deep need of individuals to assert themselves. Maybe we cannot all start cooking meth, but, like Walt and Jesse, we can all find some way of proving, at least to ourselves, that we are not losers.

Statement of Purpose

Upon telling my mother that I am starting up my blog again, she said, "Just don't write so much about yourself." To appease her and others like her who ask every writer, commentator, politician, artist, actor, etc. to justify their existence and activity, I offer an explanation of why I want to write a blog and why I feel justified in doing so.

If you are reading this, you might be wondering, “Why should she get to have a blog? What does she know and why should I care about it?” If I were an outsider reading this blog I would wonder those very same things; unlike many commentators on Fox News, I consider a questioning of what qualifies me to pass judgment on the world a valid inquiry. I present two different theories.

In this instance, like so many others in my life, Pete Townshend of the Who can better speak for me than I can speak for myself. In a song called “Guitar and Pen”—a song arguably beneath Pete’s extraordinary talents as a songwriter that appears on the wildly uneven, swan-song album Who Are You—Pete addresses a hypothetical teenage audience member, who of course stands in for Pete himself: “You’re alone above the street somewhere/ Wondering how you’ll ever count out there.” Never mind that big-nosed Pete had already achieved phenomenal success as a rock star and more than proved that he “counted;” by 1978, the year this song came out, booze had completely torpedoed Pete’s never-steady self-confidence. 

            As usual Pete hits the nail right on the head, the nail being the fragile psyche of Kristina Caffrey. I wonder every day how I’ll ever “count” in a huge, overpopulated, deeply confused world. Perhaps certain members of this audience also wonder how they will “count.” Perhaps none of you share my existential paranoia. Perhaps none of you have such inflated egos that you feel that you should count. Maybe some people do not even want to count. The subject of “counting” deserves an entire blog post devoted exclusively to the topic, so I will stop here and simply reiterate that I do wonder how I will count out there.

            But never fear, Pete said to both himself and the legions of followers showering him with messianic praise. “You can walk, you can talk, you can fight/ But inside you've got something to write/ In your hand you hold your only friend/ Never spend your guitar or your pen.”

            We could use up an entire blog post debating whether or not one can use fighting to create meaning in one’s life and one’s world in 2011. Individuals, at least the last time I checked, can still walk and talk without too many legal obstacles. Pete advises, however, that walking, talking, and fighting do not have the same “counting capacity” as writing does. And yes, I totally made up that term: “counting capacity,” meaning the capacity of an activity to help the actor “count” within a given setting.

            Thank you, Pete, for giving me support for the contention that I do have something to write. I always knew that I had this something, but it took me many years to figure out what that something was. Of course, I will not just simply claim that I have something to write. I will attempt to prove on this blog that I have quite significant and meaningful things to write. I believe that a writer is nothing without an audience, so it will be in part up to you, my hopefully faithful readers, to decide if I should, counter to Pete’s advice, spend my guitar and pen.

            So, in a nutshell, that is why I am writing this blog.

On the other hand, we can subscribe to the Walt Whitman theory of writing, which basically states that if you are a sentient creature, you have an unalienable right to write, to sing, to speak, to make others listen to you, and to simply be. The only qualification needed to pass judgment on the world and oneself is mere consciousness. In the 20th section of his magnum opus “Song of Myself,” Walt wrote, “I do not trouble my spirit to vindicate itself or be understood. I exist as I am, that is enough.”

If I take the same approach to writing as Walt took to being, then in fact I do not have to trouble my writing to vindicate itself. I write as I do, and that is enough.

If it’s enough for Walt, it’s enough for me. That is additionally why I am writing this blog.

A Mammoth Missed Opportunity

http://www.msnbc.msn.com/id/44200347/ns/technology_and_science-science/t/reindeer-herder-finds-remains-baby-mammoth-russias-arctic/

For today's entry in the annals of Missed-Opportunities-to-Make-a-Climate-Change-Connection, I point you to a recent discovery of another perfectly-preserved wooly mammoth body frozen in the Siberian tundra. Another similarly preserved mammoth specimen was unearthed in 2007 in the same region of Russia. The story above says that a reindeer herder found the baby mammoth "poking out of the permafrost." In this description the article misses a giant opportunity to make a climate change connection.
I applaud the discovery of a well-preserved specimen of an ancient species. Paleontologists can study this new find and glean important details about Ice Age animals and their eventual extinction. However, I cannot applaud the conditions that made this discovery possible. The article fails to even hint that climate change led to this discovery. You might ask, "How? That's rather a large leap to make!"  
Climate change led to the discovery of this 40,000 year old mammoth by melting vast swaths of Siberian and Arctic permafrost. As the permafrost melts, things long frozen and buried beneath the ice become uncovered. That little mammoth had spent 40,000 years frozen in the tundra, and in that time no human or animal disturbed it. No seismic activity uncovered it. No wandering nomad found it. But now, as reports come in (see below) of Russia's rapidly melting permafrost, this little mammoth was found. I do not think it is a coincidence.

http://www.guardian.co.uk/environment/2009/oct/20/arctic-tundra

http://climatechangearticles.blogspot.com/2011/08/russias-permafrost-melting-will-add-to.html

As the Russian tundra melts, expect to see more mammoths. But while it would be incredibly awesome to actually recreate mammoths, we must remember that the only reason we have these specimens and their DNA is climate change.

The Press Has a Climate Change Blind Spot

http://www.examiner.com/homeland-security-in-chicago/the-year-s-disasters-prompt-initiative-for-a-weather-ready-nation


http://latimesblogs.latimes.com/nationnow/2011/08/2011-the-year-of-the-billion-dollar-weather-disasters.html

http://www.usatoday.com/news/nation/environment/2011-08-17-record-weather-disasters_n.htm

http://www.washingtonpost.com/blogs/capital-weather-gang/post/with-extreme-weather-off-the-charts-national-weather-service-launches-weather-ready-initiative/2011/08/17/gIQA2xjULJ_blog.html

The journalists and reporters of the United States of America have a giant collective blind spot. This spot enables them to report on extreme weather and the extreme costs of that weather without asking the kind of hard-hitting, probing questions we expect of even our most incompetent members of the press these days: “Why is this happening?” “What can be done about it?”
I have linked four articles for your viewing pleasure that report on the economic impacts of 2011’s extreme weather. These articles come from reputable publications—OK, OK, USA Today may not be a paragon of journalistic exactitude, but it is at least somewhat reputable. Neither the national paper nor news outlets in the major cities of Los Angeles and Chicago even mentioned the words “climate change” in their coverage of the costs of extreme weather. And the Washington Post, the newspaper of Bernstein and Woodward, merely says that “some people” point to climate change as a cause. Yes, I know this article appeared on the Post’s online blog, and yes, at least the writer linked to a responsible authority on climate change.
If “Samenow” is truly the surname of the Washington Post writer, it could not more accurately describe his journalistic attitude: stick to the status quo, don’t ask hard questions, don’t follow up, and god forbid, don’t try to actually contact a scientist directly to get an opinion! And stick straight to the Republican Party line that only “some people” believe in climate change. Keep your dismissive and sarcastic tone that suggests that climate scientists are just a bunch of eccentric eggheads. Don’t dare try to actually bring some much needed illumination to an issue of incredible public importance! Don’t try to live up to the investigative legacy of your previously ground-breaking and muck-raking publication.
I could also link many, many pieces reporting on the extreme droughts in Texas that will not go near the term “climate change” with a 10-foot cattle prod.
My big question is, “Why does the press have a blind spot when it comes to climate change?” Some journalists might offer the excuse, “I just report the news. I don’t comment on it.” I understand this perspective and understand that a responsible and ethical reporter cannot offer his or her own opinion on whether climate change is to blame for this or that disaster. However, I cannot understand that a responsible and ethical journalist would not follow up in some manner: ask questions, do original research, ask a climate scientist. Heck, even just mention it as a possibility!
The press’ climate change blind spot tends to disprove the hysterical accusations coming from the Right that the news media has a “liberal bias.” I certainly do not see the liberal bias in my review of weather-related news. And if anybody does detect such a bias in a major media outlet—we’re talking national or first-tier city newspapers and magazines—please let me know so I can post the article here and congratulate the brave and fearless reporter.
Until then, I will continue to point out the lack of discussion of climate change in weather-related reporting.